Method and apparatus for osteochondral autograft transplantation

Abstract

A method and apparatus for autogenous transplantation of articular cartilage with bone from one site, such as in the knee, to another to treat chondral defects. Graft harvesters and recipient site harvesters create identically-sized donor graft osteochondral cores and recipient sockets. Collared pins disposed within the harvesters facilitate removal of the harvested cores. Windows formed in the side of the harvester tubes allow visualization of the graft, such as when being inserted into the recipient socket. A removable three-piece driver/extractor is provided to allow for impact-driving and depth control of the harvesters into the selected sites.

What is claimed is: 
     
       1. A method of transplanting osteochondral cores in a joint having articular cartilage and subchondral bone, using a cutting tube having a distal end and a pin, the method comprising the steps of: a. inserting the pin into the cutting tube to form a cutting tube and pin assembly;   b. introducing the cutting tube into the joint;   c. placing the distal end of the cutting tube and pin assembly prior to introducing the pin into the joint over a selected site in the joint; and   d. driving the distal end of the cutting tube into the subchondral bone to a predetermined depth to form an osteochondral core.   
     
     
       2. The method of claim 1, further comprising the step of removing the cutting tube from the joint with the osteochondral core. 
     
     
       3. The method of claim 2, wherein the osteochondral core has a cancellous base, the method further comprising the step of rotating the cutting tube having been driven to the specified depth to fracture the cancellous base. 
     
     
       4. The method of claim 2, further comprising the steps of: forming a socket in the joint, the socket having an opening;   introducing the cutting tube with the osteochondral core into the joint;   positioning the distal end of the cutting tube at the opening of the socket; and   urging the pin distally so as to advance the osteochondral core into the socket.   
     
     
       5. The method of claim 4, wherein the step of forming socket in the joint is performed by removing a bone core. 
     
     
       6. The method of claim 4, further comprising the step of seating the osteochondral core so that a proximal surface of the osteochondral core is flush with the opening of the socket. 
     
     
       7. The method of claim 4, wherein the step of forming the socket comprises performing steps a through d of claim 1 using a cutting tube having an outer diameter equal to an outer diameter of the osteochondral core. 
     
     
       8. The method of claim 4, further comprising the step of measuring the socket with an alignment stick. 
     
     
       9. The method of claim 4, further comprising the step of shaping the socket with an alignment stick. 
     
     
       10. The method of claim 1, wherein the cutting tube is driven without rotation. 
     
     
       11. The method of claim 1, wherein the step of driving the cutting tube comprises impacting the cutting tube. 
     
     
       12. The method of claim 1, wherein the pin has a collar. 
     
     
       13. A method of transplanting osteochondral cores in a joint having articular cartilage and subchondral bone, using a cutting tube having a distal end and slotted windows, and a pin slidably disposed within the tube, the method comprising the steps of: a) introducing the cutting tube into the joint;   b) placing the distal end of the cutting tube over a selected site in the joint;   c) driving the cutting tube into the subchondral bone to form an osteochondral core;   d) removing the cutting tube with the osteochondral core from the selected site;   e) visualizing the osteochondral core within the cutting tube; and   f) advancing the pin with respect to the cutting tube so as to urge the osteochondral core from the cutting tube.   
     
     
       14. The method of claim 13, wherein the cutting tube has an inner diameter, and the method further comprises the step of: forming a socket at a recipient site using a recipient tube having an outer diameter equal to the inner diameter of the cutting tube; and   wherein, in the step of advancing the pin with respect to the cutting tube, the osteochondral core is urged from the cutting tube into the socket formed at the recipient site.   
     
     
       15. A method of transplanting osteochondral cores in a joint having articular cartilage and subchondral bone, using a tube having means for visualizing an osteochondral core contained within the tube, the method comprising the steps of: a) introducing an osteochondral core into the tube;   b) introducing the tube to a socket formed at a recipient site within the joint;   c) urging the osteochondral core from the tube into the socket;   d) visualizing the osteochondral core within the tube by way of the visualization means; and   e) orienting the osteochondral core with respect to the socket at the recipient site.   
     
     
       16. The method of claim 15, wherein the step of introducing the osteochondral core into the tube comprises the step of: cutting the osteochondral core from a donor site using the tube, the tube comprising a donor tube having an inner diameter; and   wherein the socket formed at the recipient site within the joint is formed using a recipient tube having an outer diameter equal to the inner diameter of the donor tube.   
     
     
       17. A method of transplanting osteochondral cores in a joint having articular cartilage and subchondral bone, using a tube having a distal end and a pin, the method comprising the steps of: inserting the pin into the tube;   placing the distal end of the tube over a selected site in the joint;   introducing an osteochondral bone core into the tube;   removing the tube from the selected site with the bone core remaining within the tube;   positioning the distal end of the tube at an opening of a bone socket; and   urging the pin distally so as to advance the bone core into the bone socket.   
     
     
       18. The method of claim 17, wherein the pin has a collar. 
     
     
       19. The method of claim 17, wherein the bone socket is formed by cutting with a tube having an outer diameter equal to an outer diameter of the osteochondral core. 
     
     
       20. The method of claim 17, wherein the step of inserting the pin into the tube is performed prior to the step of introducing the osteochondral bone core into the tube.